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Linda A Hershey, Rhonda Coleman-Jackson
Dementia with Lewy bodies (DLB) is a complex disease that involves a variety of cognitive, behavioral and neurological symptoms, including progressive memory loss, visual hallucinations, parkinsonism, cognitive fluctuations and rapid eye movement sleep behavior disorder (RBD). These symptoms may appear in varying combinations and levels of severity in each patient who is seen in the clinic, making diagnosis and treatment a challenge. DLB is the third most common of all the neurodegenerative diseases behind both Alzheimer's disease and Parkinson's disease (PD)...
January 25, 2019: Drugs & Aging
Kasia Gustaw Rothenberg, Ryan Rajaram
PURPOSE OF THE REVIEW: Psychosis is broadly defined as a disengagement from reality. It describes syndromes that impair both thought content and thought process. Psychosis negatively impacts an individual's quality of life, in addition to the families caring for them. Psychosis with different types of hallucinations and delusions occurs in the context of delirium. Neuropsychiatric symptoms (NPS) are almost universal in the course of common neurodegenerative disorders (NDD) like Alzheimer's disease (AD) or Parkinson's disease (PD)...
January 23, 2019: Current Treatment Options in Neurology
Jennifer de la Cruz, Clinton Canal
Pimavanserin is a first-in-class selective serotonin 5-HT2A receptor inverse agonist approved for the treatment of Parkinson disease psychosis. This article discusses pimavanserin's mechanism of action, which patients are appropriate candidates for therapy, adverse reactions, and appropriate dosing.
January 2019: JAAPA: Official Journal of the American Academy of Physician Assistants
Kevin J Black, Henry Nasrallah, Stuart Isaacson, Mark Stacy, Rajesh Pahwa, Charles H Adler, Gustavo Alva, Jeffrey W Cooney, Daniel Kremens, Matthew A Menza, Jonathan M Meyer, Ashwin A Patkar, Tanya Simuni, Debbi A Morrissette, Stephen M Stahl
Patients with Parkinson's disease psychosis (PDP) are often treated with an atypical antipsychotic, especially quetiapine or clozapine, but side effects, lack of sufficient efficacy, or both may motivate a switch to pimavanserin, the first medication approved for management of PDP. How best to implement a switch to pimavanserin has not been clear, as there are no controlled trials or case series in the literature to provide guidance. An abrupt switch may interrupt partially effective treatment or potentially trigger rebound effects from antipsychotic withdrawal, whereas cross-taper involves potential drug interactions...
December 2018: CNS Spectrums
Neal Hermanowicz
Parkinson's disease psychosis (PDP) occurs commonly and can comprise the most troubling symptoms among the many that occur with this illness. Prior treatment options for PDP have been limited and unsatisfactory due to uneven efficacy data, burdensome monitoring, and lack of a specific FDA indication coupled with warnings of increased mortality. Pimavanserin, approved for the treatment of PDP by the FDA in 2016, overcomes some of these obstacles, with data proven efficacy and without the frequent monitoring required for clozapine...
December 2018: CNS Spectrums
Leslie Citrome
Pimavanserin is not curative, but can improve the quality of life remaining for the person with Parkinson's disease who typically has been suffering from this relentless neurodegenerative disease for years. Using pimavanserin effectively requires knowledge not only about the product itself, but also about the treatments pimavanserin is replacing.
December 2018: CNS Spectrums
Amanda E Price, Victoria D Brehm, Jonathan D Hommel, Noelle C Anastasio, Kathryn A Cunningham
Binge eating disorder (BED) is characterized by dysregulated feeding and reward-related processes, and treatment is often challenged by limited therapeutic options. The serotonin (5-HT) 5-HT2A receptor (5-HT2A R) and 5-HT2C R are implicated in both feeding-related and reward-related behaviors and are thus poised to regulate BED-related behaviors. The purpose of this study was to assess the efficacy of the FDA-approved medications pimavanserin, a 5-HT2A R antagonist/inverse agonist, and lorcaserin, a 5-HT2C R agonist, in a rodent model of binge eating...
2018: Frontiers in Pharmacology
C Ballard, J M Youakim, B Coate, S Stankovic
BACKGROUND: Pimavanserin is a 5-HT2A receptor inverse agonist/antagonist and is approved in the United States for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. OBJECTIVE: Evaluate the efficacy of pimavanserin on symptoms of psychosis in patients with Alzheimer's disease (AD). DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Nursing home residents. PARTICIPANTS: Patients with AD psychosis...
2019: Journal of Prevention of Alzheimer's Disease
John R Younce, Albert A Davis, Kevin J Black
 The atypical antipsychotic ziprasidone has been considered inappropriate for use in patients with Parkinson's disease (PD), as most atypical antipsychotics worsen parkinsonism. However, the current evidence for safety and efficacy of ziprasidone in PDP has not been evaluated in a systematic fashion. We review published experience with ziprasidone for treating psychosis in PD via systematic search of MEDLINE, Embase, Cochrane CENTRAL, and with terms related to "ziprasidone" and "Parkinson's disease", inclusive of case reports and prospective studies...
November 21, 2018: Journal of Parkinson's Disease
Alberto J Espay, Michael T Guskey, James C Norton, Bruce Coate, Joaquin A Vizcarra, Clive Ballard, Stewart A Factor, Joseph H Friedman, Anthony E Lang, Niccole J Larsen, Candace Andersson, Doral Fredericks, Daniel Weintraub
BACKGROUND: PD psychosis is often associated with cognitive impairment, including dementia, and involves dopaminergic, serotonergic, and cholinergic mechanisms. OBJECTIVE: To evaluate the differential effect of the antipsychotic pimavanserin, a selective serotonin 2A receptor inverse agonist, in PD psychosis patients with versus without cognitive impairment and in those receiving versus not receiving cognitive-enhancing medications. METHODS: Data from the pivotal randomized clinical trial of pimavanserin for PD psychosis were stratified by (1) screening MMSE score as cognitively impaired (21-24) versus unimpaired (≥25) and (2) concomitant use versus nonuse of cognitive-enhancing medications...
November 2018: Movement Disorders: Official Journal of the Movement Disorder Society
Dennis J Sholler, Sonja J Stutz, Robert G Fox, Edward L Boone, Qin Wang, Kenner C Rice, F Gerard Moeller, Noelle C Anastasio, Kathryn A Cunningham
Impulsivity and the responsivity to cocaine-linked cues ("cue reactivity") promote relapse in cocaine use disorder (CUD). A time-dependent escalation of cue reactivity ("incubation") occurs during extended forced abstinence (FA) from cocaine self-administration. The investigational serotonin (5-HT) 5-HT2A receptor (5-HT2A R) antagonist/inverse agonist M100907 suppresses impulsive action (inability to withhold premature responses) and cocaine-seeking behavior. The recent approval of the 5-HT2A R antagonist/inverse agonist pimavanserin (NUPLAZID™) provides the opportunity to assess an FDA-approved medication in preclinical analyses of relapse vulnerability...
October 29, 2018: Journal of Pharmacology and Experimental Therapeutics
Neepa Patel, Peter LeWitt, Ariel B Neikrug, Patrick Kesslak, Bruce Coate, Sonia Ancoli-Israel
INTRODUCTION: Impaired nocturnal sleep and excessive daytime sleepiness are common problems for patients with Parkinson's disease, and patients with Parkinson's disease with sleep dysfunction are 5 times more likely to experience psychotic symptoms. Pimavanserin, a 5-HT2A inverse agonist approved to treat Parkinson's disease psychosis, may improve sleep quality in patients with Parkinson's disease experiencing sleep disturbances. METHODS: Scales for Outcomes in Parkinson's Disease nighttime sleep (SCOPA-NS) and SCOPA-daytime sleepiness (DS) data obtained during 2 double-blind placebo-controlled studies of pimavanserin in persons with Parkinson's disease psychosis were evaluated...
November 2018: Clinical Neuropharmacology
J Cummings, C Ballard, P Tariot, R Owen, E Foff, J Youakim, J Norton, S Stankovic
Psychosis is common across dementia types with a prevalence of 20% to 70%. Currently, no pharmacologic treatment is approved for dementia-related psychosis. Atypical antipsychotics are frequently used to treat these disorders, despite significant safety concerns. Pimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved in the U.S. for treating hallucinations and delusions associated with Parkinson's disease psychosis (PDP). Patients in the pimavanserin group experienced a significant (p=0.001) improvement in Scale for the Assessment of Positive Symptoms - Parkinson's disease (SAPS-PD) scores vs...
2018: Journal of Prevention of Alzheimer's Disease
Baland Jalal
Sleep paralysis is a state of involuntary immobility occurring at sleep onset or offset, often accompanied by uncanny "ghost-like" hallucinations and extreme fear reactions. I provide here a neuropharmacological account for these hallucinatory experiences by evoking the role of the serotonin 2A receptor (5-HT2A R). Research has shown that 5-HT2A R activation can induce visual hallucinations, "mystical" subjective states, and out-of-body experiences (OBEs), and modulate fear circuits. Hallucinatory experiences triggered by serotonin-serotonergic ("pseudo") hallucinations, induced by hallucinogenic drugs-tend to be "dream-like" with the experiencer having insight ("meta-awareness") that he is hallucinating, unlike dopaminergic ("psychotic" and "life-like") hallucinations where such insight is lost...
November 2018: Psychopharmacology
Gabriel M Moreno, Rhea Gandhi, Stephanie L Lessig, Brenton Wright, Irene Litvan, Fatta B Nahab
No abstract text is available yet for this article.
September 26, 2018: Neurology
Abigail C Keys Lawler, Yasar Torres-Yaghi, Fahd Amjad, Charbel Moussa, Fernando Pagan
No abstract text is available yet for this article.
June 2018: Neurology. Clinical Practice
Brian D Berman, Trevor Hawkins
No abstract text is available yet for this article.
June 2018: Neurology. Clinical Practice
Sarah Schubmehl, Joleen Sussman
No abstract text is available yet for this article.
October 2018: American Journal of Geriatric Psychiatry
Sarah Schubmehl, Joleen Sussman
In 2016, pimavanserin, a 5-hydroxytryptamine 2A inverse agonist, became the first U.S. Food and Drug Administration (FDA) approved medication for Parkinson disease psychosis (PDP) after demonstrating modest clinical improvement in a single positive trial as assessed by a novel PDP scale, the Scale for the Assessment of Positive Symptoms for Parkinson's Disease Psychosis (SAPS-PD). This followed three trials that demonstrated negative findings on established measures of psychosis widely used in PDP research, including the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, the Parkinson Psychosis Rating Scale, and the Clinical Global Impression-Severity Scale...
October 2018: American Journal of Geriatric Psychiatry
Abhimanyu Mahajan, Bisena Bulica, Ayesha Ahmad, Patricia Kaminski, Peter LeWitt, Danette Taylor, Shana Krstevska, Neepa Patel
BACKGROUND: Parkinson's disease psychosis (PDP) is a disabling non-motor symptom of Parkinson's disease (PD) that is challenging to treat. Dopamine receptor blockers (DRB) are used to treat PDP, though these may be associated with adverse effects, including worsening of Parkinsonism. Pimavanserin, a selective 5-HT2A receptor inverse agonist, was recently FDA-approved for treatment of PDP; however, there is limited information on its long-term use in PDP patients. METHODS: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017...
October 2018: Neurological Sciences
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